Provider Demographics
NPI:1396889614
Name:LAIL, CHALRES MONTIE (DMD)
Entity type:Individual
Prefix:DR
First Name:CHALRES
Middle Name:MONTIE
Last Name:LAIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 31ST AVENUE LN NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-8592
Mailing Address - Country:US
Mailing Address - Phone:828-322-3770
Mailing Address - Fax:
Practice Address - Street 1:302 S CENTER ST
Practice Address - Street 2:
Practice Address - City:HILDEBRAN
Practice Address - State:NC
Practice Address - Zip Code:28637-8302
Practice Address - Country:US
Practice Address - Phone:828-397-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995084Medicaid